LTLL and Comcare (Compensation)

LTLL and Comcare (Compensation) [2016] AATA 913 (16 November 2016)

Division

GENERAL DIVISION

File number

2014/4163

LTLL

APPLICANT

And

Comcare

RESPONDENT

DECISION

Tribunal
Dr James Popple, Senior Member
Dr Bernard Hughson, Member

Date 16 November 2016

Place Canberra
1. Comcare’s decision on 11 July 2014 is affirmed.

2. The publication of these reasons for decision is to be delayed until they have been made available to the applicant through his treating psychiatrist or treating psychologist, or another similarly qualified person.

......................[sgd]..................................................
James Popple, Senior Member
CATCHWORDS
COMPENSATION — Commonwealth employees — Applicant suffered relapse of previously diagnosed mental illness — Applicant suffered an aggravation of an ailment — appropriate diagnosis of Applicant’s ailment — whether Applicant was subject to bullying and harassment in the workplace — whether aggravation of ailment was contributed to, to a significant degree, by employment — decision under review affirmed.

LEGISLATION
Safety, Rehabilitation and Compensation Act 1988, ss 4(1), 5A, 5B, 14

CASES
Wiegand v Comcare Australia (2002) 72 ALD 795

REASONS FOR DECISION
Dr James Popple, Senior Member
Dr Bernard Hughson, Member
16 November 2016
Summary

The applicant suffered a relapse of chronic paranoid schizophrenia. He claimed that the relapse had been caused by a combination of workplace stress and an unresolved bullying complaint. He sought compensation under the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act). Comcare conceded that the applicant had suffered a relapse, but denied liability under s 14 of the SRC Act. Comcare said that the applicant’s relapse was not contributed to by his employment with an agency of the Commonwealth (the agency).
The applicant was not subject to bullying and harassment in the workplace, but he perceived the agency’s actions as bullying and harassment. However, this perception did not contribute to his relapse to a significant degree: that is, to a degree that was substantially more than material. The only factor that contributed to that degree was that the applicant had stopped taking anti-psychotic medication.
Because the applicant’s relapse was not contributed to, to a significant degree, by his employment, his relapse is not a disease for the purposes of s 5B of the SRC Act. That means that the relapse is not an injury for the purposes of s 14. Comcare is not liable to pay the applicant compensation in respect of the relapse of his mental illness.
Background
“LTLL”[1] (the applicant) has been employed by the agency since December 2011. On 15 November 2013, he made a claim for compensation for chronic paranoid schizophrenia.[2] He claimed that this was caused by a combination of workplace stress and an unresolved bullying complaint. On 20 February 2014, Comcare denied that it was liable to pay him compensation under s 14 of the SRC Act for what it characterised as “paranoid type schizophrenia”.
[1] On 24 October 2014, the Tribunal (Bean DP) directed, pursuant to s 35(2) of the Administrative Appeals Tribunal Act 1975, that the publication of the applicant’s name, and any information that allows him to be identified, be prohibited, and that he be identified by a pseudonym. We have withheld some relevant factual detail from these reasons for decision, to ensure that the applicant cannot be identified from these reasons.
[2] At the hearing, the applicant explained that he seeks compensation in relation to the period 26 August 2013 (when he first saw GP B—see [30] below) until 4 August 2014 (when he returned to work at the agency).
On 30 April 2014, the applicant requested a reconsideration of that determination. On 11 July 2014, Comcare affirmed its determination.
On 12 August 2014, the applicant applied to the Tribunal, under s 64 of the SRC Act, for review of that decision.
Decision under review
The decision under review is Comcare’s decision on 11 July 2014 to affirm its determination that Comcare is not liable to pay compensation to the applicant.
Issues
The applicant had previously been diagnosed with a mental illness. He says that the aggravation of an ailment for which he seeks compensation was a relapse of his mental illness. He says that that aggravation was contributed to, to a significant degree, by his employment by the agency. Comcare accepts that the applicant suffered an aggravation, but denies that it was contributed to by the applicant’s employment.
So, the issues in this review are:
·What is the appropriate diagnosis of the applicant’s ailment?
·Was the applicant subject to bullying and harassment in the workplace?
·Was the aggravation of the applicant’s ailment contributed to, to a significant degree, by his employment by the agency?
The applicant’s medical history
On 7 November 2006, a psychiatrist (psychiatrist A) concluded that the applicant did not then suffer from a mental illness, though he thought it likely that he had an autistic spectrum disorder. On 7 March 2007, psychiatrist A diagnosed the applicant as having suffered a “brief reactive psychosis” and as suffering “[h]igh functioning autistic spectrum disorder and possible complex post-traumatic stress disorder with regression triggered by recent stressors”.[3] We will call this the first episode. The applicant was admitted to psychiatric care, and was put on anti-psychotic medication. Psychiatrist A anticipated that the applicant’s condition would “only last for weeks, as it does not appear to be indicative of a schizophreniform psychosis (in mental state or in onset)”. On 16 March, psychiatrist A noted that the applicant had made “a remarkable recovery” and that “[t]here was no evidence of psychosis or mood disturbance”. The applicant’s dosage of medication was reduced. On 21 March, psychiatrist A reported that the applicant’s condition had deteriorated and he had “returned to his previous condition”. The original level of medication was reinstated.
[3] We have corrected some typographical errors in this, and in other quotations from the evidence.
On 30 March 2007, psychiatrist B reported that he “tend[ed] to lean towards a diagnosis of a chronic process as opposed to a reactive psychosis”. On the same day, psychiatrist A noted that there had been reports that the applicant had not been taking his oral medication, and that his periods of psychosis continued. Psychiatrist A recommended that the applicant be given his medication by depot injection. The applicant agreed to one depot injection, which would appear to have been administered in April.
On 12 April 2007, psychiatrist A applied for a psychiatric treatment order (PTO) under the relevant mental health legislation. In the application, psychiatrist A said that the applicant was not capable of giving informed consent to treatment, and diagnosed him as suffering from a “schizophreniform psychotic disorder, possibly with a good prognosis (i.e. ultimately experiencing full remission rather than a chronic unremitting course)”. On 19 April 2007, the PTO was made for six months. Further PTOs were made, each for six months, covering the period until 21 March 2011, when the then current PTO was revoked.
Several depot injections were administered, but in October 2007 these injections ceased (at the applicant’s request) and he was prescribed oral medication. By June 2008, he had stopped taking his oral medication.
On 7 August 2008, the applicant was released from psychiatric care, but presented at hospital later that day with what the treating medical staff described as a “major depressive episode” and a “[r]elapse of schizophrenia”. We will call this the second episode. He was readmitted to psychiatric care. He was released on 2 September, then readmitted after two days. On 30 September, he was released again.
Depot injections were administered to the applicant approximately every 2–4 weeks between 9 August 2008 and 3 August 2010. At various times during this period and after it, the applicant told those treating him that he did not need medication. For example, on 19 March 2008, when psychiatrist A applied for the second of the further PTOs, he reported that the applicant was “convinced that he did not suffer from a schizophreniform illness and that he did not benefit from medications”. On 18 March 2010, a psychologist (psychologist A) reported that the applicant “did not believe that medication had contributed significantly to improving his mental state”. On 22 September 2010, when psychiatrist C applied for the third of the further PTOs, he reported that the applicant had “partial insight into the reason he’s on medication and on a PTO, but he believes his condition was a temporary stress-induced one, rather than a severe mental illness of the nature of schizophrenia”. And, on 6 January 2011, psychologist A reported that the applicant “does not consider that medication was essential to his recovery from the second episode … preferring to believe that he would have been able to recover on his own by being removed from the source of his stress, applying logical thinking”.
On 22 September 2010, psychiatrist C reported that the applicant’s mental state was “stable” and his “level of functioning is currently excellent”. By the end of 2010, the applicant was living with his father and his step-mother, and achieving well academically in his university studies.
In late 2010, the applicant started a four-week work placement with the agency. In January 2011, he began working for the agency on a six-month contract.
On 16 March 2011, when psychiatrist C applied to have the then current PTO revoked, he reported that:
[The applicant] has a diagnosis of paranoid schizophrenia which he disagrees with believing he has had stress-induced transient psychotic episodes. This is a possible alternative diagnosis and recent psychological treatment has focused on psycho education, the role of medication in addition to psychological techniques to help manage potential psychotic symptoms.
[The applicant] has been under my care since August 2010 and in that time has shown himself to be a thoughtful, articulate and intelligent young man. He has been able to voice his concerns regarding his medication management and we negotiated that he start on oral medications, which to the best of my knowledge he has been compliant with. Most importantly, since the cessation of [the applicant’s] depot medication there has been no evidence of psychosis.
It is not clear that the applicant was compliant with his oral medication at this stage. He was certainly non-compliant by early July 2011,[4] and may have stopped complying as much as a year earlier than that.[5]
[4] See [22] below.
[5] On 24 February 2012, a nurse reported that the applicant had disclosed, while in hospital after the third episode (in September 2011—see [21] below), that he had been non-compliant with his oral medication for 14 months: that is, from July 2010. He had the last of a series of regular depot injections on 3 August 2010 (see [15] above).
On 27 April 2011, the applicant had a regular appointment with the clinical manager. He was stressed because his routine had been disrupted for the preceding fortnight with his father and step-mother interstate. He was also stressed by his university studies and his work at the agency as a contractor.
On 12 May 2011, the applicant told psychiatrist D that he was worried about his mood. Psychiatrist D noted that the applicant “either is having an early relapse of psychosis or is in the early phase of a depressive disorder, precipitated by the increase in [his oral medication] and [university] stress”.
On 5 September 2011, the applicant’s step-mother reported, to mental health professionals, her concerns about his behaviour over the preceding week. The applicant’s father was away interstate on business. The applicant told attending mental health professionals that he had ceased all medications, though he was not sure how long ago. He was voluntarily readmitted to psychiatric care. Early the next morning, psychiatrist E diagnosed an “[a]cute psychotic relapse due to non-compliance of [sic] medication”. We will call this the third episode.
On 7 September 2011, psychiatrist F applied for a PTO, reporting that the applicant had suffered a “relapse of schizophrenia due to non-compliance with medications, multiple stress” and use of a medication for an unrelated physical condition. He reported that the applicant had been non-compliant with his medication for 2–3 months. On 12 September, a PTO was made for six months; a further PTO was made in March 2012. On 15 September, psychiatrist G reported that the applicant’s father and sister both thought that his condition had deteriorated over the preceding two months. The applicant later admitted to having ceased taking his medication in July 2011.[6]
[6] Reported by psychiatrist C on 14 February 2012. But see also note 5 above.
The applicant was given medication, even though he continued to disagree that he needed it. He asked that he not be given depot injections, and suggested that his father could oversee his compliance with oral medication. But, on 20 September, psychiatrist C and psychiatrist H agreed that that would be “too much of an imposition on his father” given the applicant’s “extreme reluctance to take treatment”.
On 22 September 2011, the applicant was discharged from psychiatric care.
On 19 December 2011, the applicant became an ongoing employee of the agency.
On 17 February 2012, when a mental health worker applied for a further PTO, he reported that the applicant was “frank about feeling stigmatized by a mental illness which he believes he does not have” and that he was “firm in his belief that he does not have a mental illness now, that his psychosis was time-limited and a reaction to stress that does not require treatment currently”. The applicant opposed the further PTO. He said that he did not have a “permanent psychotic illness” and that the side-effects of his medication were preventing him from living a normal life.
Depot injections were administered regularly between 20 September 2011 and 26 July 2012. These injections ceased because, in August 2012, the applicant moved interstate and was no longer subject to the then current PTO, which was revoked (for that reason) on 6 September 2012.
On 3 July 2013—almost a year after his previous depot injection—the applicant saw his general practitioner (GP A). By this stage, the applicant had returned to living with his father and step-mother. GP A’s notes record that the applicant was “very stress[ed] at work”, “unable to cope”, and “stress[ed] at home and work”. He identified “issues with step-mother at home—which is going to resolve as she is going away to work”. The applicant told GP A that he had seen a psychologist through his work, and that “work stress is continuing—unable to adjust well to chnages [sic: changes]”. He also said that he “feels very anxious”. On 11 July, the applicant told GP A that he was no longer anxious, that things had improved at home because his father and step-mother had gone away,[7] and that “work issues [are] also improving—so [he is] feeling less stressful now”. At the hearing, the applicant maintained that his mental health had not improved by that time: that he was, at that time, psychotic. Certainly things were not all well by 13 August, when the applicant saw GP A again. GP A noted that “overall it appears like [the applicant is] having issues at work—adjustment problems”.
[7] See [60] below.
On 4 July 2013, the agency’s human resources area (the HR area) referred the applicant to psychologist B.[8] Psychologist B interviewed the applicant on 10 and 31 July 2013. On 1 August, he reported that the applicant “appeared to be suffering from mild anxiety and stress related to work and home problems”, and that the applicant “demonstrated schizotypal personality traits”.
[8] The applicant’s supervisor had notified the HR area that the applicant was experiencing “personal issues”: see [57] below.
On 26 August 2013, the applicant saw GP B. On 19 November 2013, GP B provided a medical certificate in support of the applicant’s compensation claim, which described the applicant’s “injury/aetiology” as “[e]xtreme stress at work beginning May 2013”. He listed some specific work events,[9] and concluded that these had “led to [a] relapse of chronic paranoid schizophrenia which was diagnosed in 2008”. (For reasons given below,[10] we disagree with GP B’s conclusion that workplace stressors were a significant contributor to the applicant’s condition. We note that his conclusion would appear to have been based largely on the history that the applicant gave him. We also note that GP B reported on 14 December 2013 that others, including psychiatrist I, “may be [in] a better position” to provide a more detailed report on the applicant.)
[9] The applicant’s work history is discussed at [41]–[60] below.
[10] See [93]–[99] below.
On 26 August 2013, the applicant saw psychiatrist I. On 6 September, psychiatrist I reported that the applicant was not fit for duty in any capacity. He said that the applicant presented with active psychosis and was “experiencing delusions, hallucinations and disorganisation”. He recommended that the applicant engage the services of a psychiatrist to commence anti-psychotic treatment. Psychiatrist I reported that the applicant had admitted stopping his medication sometime in 2012, but would not tell him when. Psychiatrist I said it was likely the applicant had stopped taking his medication in August 2012.
On 2 September 2013, the applicant saw the clinical manager. She recorded that the applicant “acknowledged conflict with his supervisor at work, and with [his step-mother] at home, and that there was a cross over between these two environments”.
On 12 September 2013, GP C referred the applicant to mental health professionals. The referral notes that the applicant had been asked to go on leave from work until he was well. It also notes that the applicant had not engaged with mental health services “for a while” because of “his fear of incarceration and being forced onto medication with side effects”.
On 13 September 2013, psychologist A reported that psychologist B had advised her that the applicant’s “behaviour at work had begun to deteriorate in the last quarter of 2012 (some few months after ceasing treatment)”.
On 18 September 2013, the applicant saw psychiatrist D, who reported that the applicant “described being distressed at home by ongoing conflict with his step-mother and her family” and said that “he has had ongoing conflict with his direct supervisor” at work. Psychiatrist D was of the view that the applicant suffered from “[u]ntreated schizophrenia with delusions of persecution, thought disorder, hallucinations and escalating hostility to others”. This is the aggravation for which the applicant seeks compensation. We will call it the fourth episode. The applicant was readmitted to psychiatric care.
On 19 September, psychiatrist D applied for a PTO. In the application, he said that the applicant suffered from schizophrenia, “which has been untreated for at least 12 months”. On 20 September, psychiatrist J reported that there had been “a recent worsening in [the applicant’s] mental state within the context of several stressors likely leading to exacerbation of symptoms requiring treatment to prevent further deterioration and escalation in risk of aggression towards others”.
On 23 September, psychiatrist E reported that the applicant’s father had told him that he had noticed signs of relapse in his son in July when he and the step-mother returned from an interstate trip.[11]
[11] See also [60] below.

On 26 September, a PTO was made for six months. Depot injections were administered on 20 September and on 24 October 2013, when the applicant was discharged from psychiatric care.
As noted above, on 15 November 2013, the applicant made a claim for compensation.
On 11 December 2013, psychiatrist K reported that, in her view, the applicant, whom she had seen that day, had a diagnosis of schizophrenia with multiple episodes. “His illness”, she said, “has had a relapsing course with periods of acute exacerbation of symptoms which have been quite severe and disabling”.
The applicant’s work history
The aggravation, for which the applicant seeks compensation, is the fourth episode. He says that the fourth episode was contributed to, to a significant degree, by his employment by the agency. Comcare accepts that the applicant suffered the fourth episode, but denies that it was contributed to by the applicant’s employment.
We have before us statements from the following people who worked for the agency at relevant times:
·the applicant, who worked in a section (the section) which was part of the agency’s information technology area;
·a person whom we will call the supervisor, who was the applicant’s direct supervisor for some, though not all, of the relevant period;
·the supervisor’s supervisor;
·the section manager, to whom the supervisor’s supervisor reported for some of the relevant period;
·a person who also reported to the section manager but who was, for some of the relevant period, the acting section manager;
·a person who was a project manager within the section; and
·a person who worked in the HR area.
All of these people gave evidence at the hearing. In addition, another person who worked for the agency at relevant times gave evidence, though he did not provide a statement:
·the Chief Information Officer of the agency.
Two further people provided statements and gave evidence at the hearing:
·the applicant’s father; and
·the applicant’s step-mother.
Neither of them worked for the agency, but they lived with the applicant and each gave evidence about the applicant’s condition during relevant times, and what he had told them about what was happening at his work.
As noted above, the applicant started a four-week work placement with the agency in late 2010. At that time, his mental state was stable and he was functioning well.[12] It had been more than two years since the second episode. In January 2011, the applicant began working for the agency on a six-month contract, though he worked for about five months. The third episode occurred in September 2011. He became an ongoing employee of the agency on 19 December 2011.
[12] See [16] above.
In December 2012, the applicant made a written complaint about the supervisor to the section manager. He detailed things that the supervisor had done which, he said, constituted workplace bullying. These included that the supervisor had shouted at him, and would not give him meaningful work to do. The applicant also detailed several incidents relating to the assignment of work, which he said involved bullying behaviour by the supervisor. He asked to be supervised by the supervisor’s supervisor.
The supervisor’s supervisor says that the applicant had “an obsessive focus on his work”; that he “seemed only interested in performing work in his own way”; and that he was “disinclined to take advice”. He says that the supervisor felt threatened by the applicant (who is physically larger than him) especially when the applicant became agitated. He also says that the supervisor, who was considerably more experienced than the applicant, had attempted to guide the applicant on technical issues, “but had not been able to make much headway”.
The project manager worked a few metres away from the applicant and the supervisor. She said that she never observed the supervisor shouting at the applicant in their shared work area (contrary to the applicant’s claims), though she did observe the applicant shouting at the supervisor. She said that this was a common occurrence, and it became more common after the applicant had made his complaint about the supervisor in December 2012.
After the applicant made his complaint, the section manager asked the project manager to “sit in on” a meeting (the mediation) between the applicant and the supervisor. The section manager told her that “there would be a better chance of the applicant and [the supervisor] engaging constructively if [the project manager] attended”. The mediation happened in December 2012. The project manager says that “the tone of the meeting did degenerate a little bit” and both the applicant and the supervisor “tended to interrupt whilst the other was speaking”. She says that the two of them shouted at each other. But they did agree on some things, including that they would be more respectful to each other in the future. On 4 January 2013, the section manager advised the HR area that the applicant and the supervisor “had agreed to work together, with [the supervisor] taking a ‘back off’ approach to his management style, and that the working relationship will be monitored over the coming weeks”. The project manager agrees that the relationship between the applicant and the supervisor did “settle down for a period of time” (she said that that was for about 2–3 weeks), but she says that the “mediation probably did not bring about any long term change”.
The applicant says that his complaint was not properly resolved, which caused him stress. The agency says that, “[g]iven the progress made during January and February [2013], and no further incident being brought to either [the section manager’s] or [the HR area’s] attention, no further action or intervention was assessed as necessary”.
The project manager says that she noticed changes in the applicant’s behaviour at work from as early as December 2012. She says that he had lost weight, was getting more frustrated and agitated, would sometimes disappear from work, and became dishevelled. She also says that the applicant would “snap at [the supervisor] in team meetings and interact in a rude and inappropriate manner”. The applicant, she said, “was frequently concerned with tangential issues and complained about the ‘fairness’ of work tasks”.
The applicant worked on a particular project between January and May 2013. He says that he did so with “minimal mentoring or support”. The agency denies that he was not adequately supported.
The section manager says that, after the bullying claim, he became aware of issues with the applicant’s work, and grew concerned about the applicant’s welfare as he was “clearly very stressed”. In February 2013, he says, “more serious signs of [the applicant’s] ability to focus at work began to surface”. The applicant “became very stressed at his work on [the project he was working on] and would leave work abruptly, often notifying [the supervisor] after he had gone”. From late April, he says, the applicant’s attendance at work became “more sporadic”. The applicant challenged the section manager about this evidence at the hearing, and points to leave records which do not indicate that he took leave at these times. The section manager stood by his recollection of these events (implying that not all of the applicant’s leave was authorised). And we note that we have before us an e-mail that the supervisor sent the section manager on 16 February 2013 which confirms that (at least once) the applicant did leave work abruptly, and that the supervisor was concerned at that time about the applicant’s health.
The project manager says that the applicant told her, before Easter, that he was not getting on with his sister (who lived interstate) or with his step-mother (with whom he was then living, together with his father), and that he felt he had nowhere to go for Easter. The Easter holiday was from 29 March to 1 April in 2013. The applicant says that the project manager is mistaken about the timing of this discussion, and about the timing of the changes that she noticed in his behaviour, but we accept her evidence.
In May 2013, the applicant was interviewed for a security clearance. He felt that the interview did not go well, and he became very worried about it.
On 20 May 2013, the applicant sent an e-mail to another staff member of the agency which the section manager thought was insulting. The section manager counselled the applicant against repeating that behaviour.
The agency says that the supervisor and others in the section had noticed that the applicant “was having difficulty at work, with a noticeable decline in his ability to: follow directions; complete tasks and meet deadlines; maintain an appropriate attendance pattern; interact with others; behave appropriately in the workplace”. The agency says that “[i]n May/June, it was agreed that [the applicant] would work a four day week (using annual leave one day per week) … to help him deal with the various stressors impacting on him”. These stressors, the agency says, “at various stages included family issues and concern about his security assessment”.
On 18 June 2013, the section manager advised the HR area that the applicant’s “attendance, performance and behaviour was not only affecting [the applicant’s] ability to function as part of the team, but was also causing stress and confusion in the team and starting to hinder the team’s ability to carry out its normal work”.
On 20 June 2013, the supervisor conducted the applicant’s annual end-of-cycle performance review. He rated the applicant’s performance as “meets expectations” and, on the performance review form, commented that the applicant had delivered one project, been a “critical member/developer” of another project, and was “good on production support”. The supervisor also commented that “lately (from mid-May) [the applicant] has been on and off from work due to his personal issues. I have notified him and [the HR area] and I have asked him to get help”. The applicant commented that he agreed with the supervisor’s comments. As noted above,[13] on 4 July 2013 the HR area referred the applicant to psychologist B.
[13] See [29] above.
The acting section manager acted as manager of the section from 10 July to 2 August 2013, while the section manager was on leave. He had been briefed about the relationship between the applicant and the supervisor. The acting section manager said that, when he commenced acting in the position, “[i]t was apparent that the applicant had been taking a lot of leave and was not doing much, if anything, whilst he was at work”. During the period that he was acting, a member of staff of the agency complained to him that the applicant had behaved inappropriately towards another member of staff. The acting section manager counselled the applicant about his behaviour, and they had a conversation for about 45 minutes. The acting section manager says that it became apparent to him, during this conversation, that the applicant was not well:
He found it difficult to focus, shifted the topic of conversation mid-sentence and displayed erratic body language. I observed that his eyes darted around, he waved his hands and his body movements seemed jerky. He was concerned that tracking software had been installed on his computer and that his mobile phone was being monitored. He would not explain who would do this.
During this conversation, the applicant “mentioned that he was having significant problems in his home life” but “did not mention any issues specifically to do with work”. The acting section manager suggested that the applicant go home for the afternoon. The applicant was reluctant to do so because, he said, that was where the problems were.
The applicant’s father and step-mother say that, in late 2012, the applicant talked at home about his troubles at work. By early 2013, they say, the applicant was talking about things at work having improved because of the changes that had been made. But, by April/May, the applicant was again complaining at home about the supervisor.
The applicant’s father says that the applicant’s mental health appeared to be good from August 2012 until May 2013. He says that the first sign of any relapse was at a family event on 27 April when the applicant had been unpleasant. But, he says, the applicant was “tolerable” to live with until late May or early June 2013. By mid-May, he says, the applicant “was sleeping poorly, was noticeably more stressed, was anxious and had begun taking scheduled time off work in an effort to recover”. He says that, when he and the step-mother returned from a trip interstate on about 18 July, the applicant was clearly not able to function normally. The applicant’s step-mother says that the applicant suffered insomnia in December 2012, but otherwise generally confirms what the applicant’s father says about the applicant’s condition.
Work stressors and relapse into schizophrenia
At the hearing, we heard evidence from a psychologist (psychologist C) and three psychiatrists (psychiatrist I, psychiatrist L and psychiatrist M).
On 20 December 2014, psychiatrist M reported that he had “no dispute with the argument about stress being likely to bring about relapse into schizophrenia” but that “[t]he only [such] stress known to me that has valid scientific documentation has the label of expressed emotion … within the family”. He continued:
To my knowledge the literature does not identify any other reliably verified form of stress. In particular, major stressful events such as war, famine, persecution or natural catastrophes do not increase the incidence of schizophrenic episodes. In other words, scientific knowledge does not support the [applicant’s] claim for compensation …
Psychiatrist M summarized his view on this point later in his report: “[t]he claim that stress can affect the course of the schizophrenia has relevance only to that resulting from critical or hostile emotional interaction with members of the family”.
At the hearing, psychiatrist M said that most relapses occur for unknown reasons. In the applicant’s case, he said, expressed emotion from family discord is the only known factor that can be regarded as a trigger. However, he added that that was not to suggest that a relapse could not occur without exposure to some sort of stressor: an episode could be an unpredictable appearance of the disorder with nothing to do with observable stress.
Psychiatrist M was asked whether non-compliance with medication alone could be the single factor in a relapse. He said that non-compliance removed the factor that guards against a relapse.[14]
[14] See also [95] and note 38 below.
On 24 May 2015, psychologist C reported that “the bullying and conflictual events that occurred between [the applicant] and [the supervisor], given that these were stressful for [the applicant], acted to trigger the relapse of his psychotic symptoms, or at the very least accelerated or aggravated the relapse of such symptoms”. He disagreed with psychiatrist M that only expressed emotion within the family could be a stressor that causes a relapse. He said that there is scientific evidence that other triggers can cause relapses. On 17 September 2015, psychiatrist M reported that “the speculative nature of most papers on the subject make them unreliable and this is true of all the papers that I have seen pressing the suggestion [psychologist C] advances”.
At the hearing, psychologist C was questioned about the possible contribution of the applicant’s non-compliance with medication to the fourth episode. In his view, the common denominator leading up to each of the applicant’s episodes was stress, not whether or not he was taking medication. He said that if non-compliance with medication were sufficient to cause a relapse, the applicant would have relapsed earlier than he did. Comcare says that psychologist C does not appreciate the importance of non-compliance.[15] We agree: as discussed below,[16] we think it crucially important that the applicant was not taking medication in the lead up to each of the four episodes.
[15] This is supported by the evidence of psychiatrist I (see [70] below), psychiatrist L (see [68]) and psychiatrist M (see [95]).
[16] See [98] below.
Psychiatrist L was of the view that the applicant suffers from a schizoaffective disorder and is on the autistic spectrum.[17] At the hearing, he said that non-compliance with medication causes schizoaffective episodes in people with a schizoaffective disorder. He said that there was only a 20% chance of a relapse if that person was compliant with their medication. He said that the timing of relapses was not predictable: if a person had a relapse within two months of not being medicated, it didn’t follow that another relapse would also happen within two months of not being medicated again.
[17] See [74] below.
In his report on 23 June 2016, psychiatrist L regretted that he was “unable to provide a definitive opinion in relation to the precipitant of” the applicant’s fourth episode. However, in his opinion, the fourth episode “is likely to have been precipitated by a combination of both poor compliance with medication and follow-up between August 2012 and September 2013; and what [the applicant] described as the significant stress he was subjected to in the workplace”. Psychiatrist L reported that it was not possible for him “to propose how much of these two factors contributed to the relapse, as in someone with an enduring mental illness which is relapsing and remitting in nature … both factors would independently and in combination increase the risk of relapse”. At the hearing, he explained that it is not possible to measure the effect of various social stressors, though it is possible to measure the effect of stopping treatment.
The applicant asked psychiatrist L, at the hearing, whether him having experienced racing thoughts at work was indicative of him suffering stress. Psychiatrist L said that he would interpret racing thoughts as a symptom of relapse, rather than attributing them to stress. However, psychiatrist L confirmed that, in his view, it was possible for workplace stress to trigger psychosis in someone who suffers from a psychological illness.
Psychiatrist I had reported, on 6 September 2013, that the applicant was psychotic and not fit for duty.[18] At the hearing, he said that the fourth episode could have been caused by critical expressed emotion. He said that it would be very unusual for such a stressor to have emerged from the workplace. If it had in this case, he said, that would have been because the applicant’s primary condition was inadequately protected by medication. Indeed, psychiatrist I said that the trigger for the fourth episode could have been the applicant having stopped taking his medication. He criticised psychologist C’s report[19] for not sufficiently emphasising the absence of adequate treatment.
[18] See [31] above.
[19] See [65]–[66] above.
Findings about the chronology of events
Before considering the issues in this review, we summarize here the relevant events and set them out in chronological order. We make the findings set out in this timeline, on the balance of probabilities. These findings are based on:
·the evidence about the applicant’s medical history (summarized at [10]–[40] above, and generally not contested); and
·the evidence about the applicant’s work history (summarized at [41]–[60] above), including the statements made by the people listed at [42] above, and the evidence that they gave at the hearing.
We have grouped the events in this timeline by their relationship to each of the four episodes.
The first episode (March 2007)
·March 2007: the first episode; applicant admitted to psychiatric care, and put on anti-psychotic medication.
·April 2007: first depot injection.
·19 April 2007: PTO made (and later renewed).
The second episode (August 2008)
·October 2007: regular depot injections cease.
·By June 2008: applicant stops taking oral medication.
·7 August 2008: applicant released from psychiatric care; the second episode; applicant readmitted to psychiatric care.
·9 August 2008: regular depot injections recommence.
·2 September 2008: applicant released from psychiatric care.
·4 September 2008: applicant readmitted to psychiatric care.
·30 September 2008: applicant released from psychiatric care.
The third episode (September 2011)
·3 August 2010: regular depot injections cease.
·Late 2010: applicant starts four-week work placement with the agency.
·January 2011: applicant starts six-month contract with the agency.
·21 March 2011: PTO revoked.
·27 April 2011: applicant tells the clinical manager that he is stressed.
·12 May 2011: applicant tells psychiatrist D that he is worried about his mood; psychiatrist D notes that applicant “either is having an early relapse of psychosis or is in the early phase of a depressive disorder”.
·June 2011: applicant finishes contract with the agency.
·By early July 2011 (and probably earlier): applicant stops taking oral medication.
·5 September 2011: the third episode; applicant readmitted to psychiatric care.
·12 September 2011: PTO made (and later renewed).
·20 September 2011: regular depot injections recommence.
·22 September 2011: applicant discharged from psychiatric care.
·19 December 2011: applicant becomes an ongoing employee of the agency.
The fourth episode (September 2013)
·26 July 2012: regular depot injections cease.
·August 2012: applicant moves interstate.
·6 September 2012: PTO revoked (because applicant moved interstate).
·Before December 2012: a common occurrence for applicant to shout at supervisor.
·Late 2012: applicant complains, to father and step-mother, about troubles at work.
·December 2012: applicant complains to section manager about workplace bullying by supervisor.
·December 2012: project manager conducts mediation between applicant and supervisor; applicant and supervisor shout at each other, but also come to agreement about how they can work together.
·From December 2012: applicant clearly very stressed at work; shouts at supervisor; snaps at supervisor in team meetings; and interacts in a rude and inappropriate manner.
·4 January 2013: section manager advises HR area that applicant and supervisor have agreed to work together, and that supervisor will take a “back off” approach.
·Early 2013: applicant talks at home about things at work having improved.
·From February 2013: applicant shows signs of inability to focus at work.
·16 February 2013 (and on other occasions): applicant leaves work abruptly.
·Before 29 March 2013: applicant tells project manager that he is not getting on with his sister or step-mother, and that he has nowhere to go for Easter.
·From late April 2013: applicant’s attendance at work becomes more sporadic.
·27 April 2012: applicant unpleasant at a family event.
·By April/May 2013: applicant complains, to father and step-mother, about supervisor.
·May 2013: applicant interviewed for security clearance; applicant becomes worried about security clearance.
·By mid-May: applicant sleeping poorly, noticeably (at home) more stressed and anxious.
·May/June: applicant starts using annual leave to work four-day weeks.
·18 June 2013: section manager tells HR area that applicant’s attendance, performance and behaviour causing stress and confusion in team.
·20 June 2013: supervisor conducts applicant’s annual end-of-cycle performance review; applicant rated “meets expectations”; supervisor comments that applicant has been on and off from work due to personal issues since mid-May; applicant agrees.
·3 July 2013: applicant tells GP A that he is “very stress[ed] at work”, “unable to cope”, “stress[ed] at home and work”, and “feels very anxious”.
·4 July 2013: HR area refers applicant to psychologist B.
·11 July 2013: applicant tells GP A that he is no longer anxious, and that things have improved at home and work.
·About 18 July 2013: according to father, applicant clearly unable to function.
·July/August 2013: member of agency staff complains to acting section manager that applicant behaved inappropriately towards another staff member; acting section manager counsels applicant who appears unwell, and who is reluctant to go home because that is where the problems are.
·26 August 2013: applicant first sees GP B, who later reports that applicant suffered “[e]xtreme stress at work beginning May 2013”.
·6 September 2013: psychiatrist I reports that applicant is not fit for duty in any capacity, and needs to commence anti-psychotic treatment.
·18 September 2013: the fourth episode; applicant readmitted to psychiatric care.
·20 September 2013: regular depot injections recommence.
·26 September 2013: PTO made.
·24 October 2013: applicant discharged from psychiatric care.
·15 November 2013: applicant makes claim for compensation.

This timeline demonstrates a clear pattern in the applicant’s medical health. As psychiatrist I said at the hearing, the applicant responds well to treatment (including anti-psychotic medication) and suffers a substantial decline without treatment.
What is the appropriate diagnosis of the applicant’s ailment?
Since the first episode, the applicant has variously been diagnosed as suffering from paranoid schizophrenia or a schizoaffective disorder.
In psychiatrist L’s view the applicant’s mental illness “is more consistent with schizoaffective disorder rather than schizophrenia”. This, he said, is because the applicant “certainly meets the criteria for schizophrenia but in addition to his reported delusional beliefs, there are also episodes of marked mood disturbance characterised by poor sleep, grandiosity, racing thoughts, pressured speech and thought disorder in the form of tangential and irrelevant responses”. Psychiatrist L also says that the applicant “meets the diagnostic criteria for an autistic spectrum disorder without accompanying intellectual impairment”.
Psychiatrist M says that the applicant has “chronic paranoid schizophrenia”. He also says that “the diagnosis of Asperger’s syndrome” (an autism spectrum disorder) “in this case is misleading” because “it does not provide any guide to cause or management” or “add any information of value”.
At the hearing, psychiatrist I said that there is only a small difference between the diagnoses of schizophrenia and schizoaffective disorder, and that that it is common for psychiatrists to differ about which is correct. Psychiatrist M said that there is no difference.
We find, on the balance of probabilities, that the fourth episode was an aggravation of the applicant’s ailment—a relapse of his chronic paranoid schizophrenia. In making that finding, we note that:
·paranoid schizophrenia and schizoaffective disorder are very similar diagnoses, and both on the same spectrum of disorders; and
·psychiatrist I and psychiatrist L each said that the treatment for each diagnosis is the same.
We have found that the fourth episode was an aggravation of an ailment, as opposed to an ailment. Nothing turns on this, because of the definition of “disease” in s 5B of the SRC Act (quoted below[20]): the same issues would arise if the fourth episode were an ailment, and not an aggravation.
[20] See [85] below.
Was the applicant subject to bullying and harassment in the workplace?
The applicant claims that he was bullied and harassed while working for the agency. He says that a number of workplace stressors contributed to the fourth episode. Some of those we have mentioned above in the context of the applicant’s claims about the supervisor in his December 2012 complaint: that the supervisor had shouted at him; that the supervisor would not give him meaningful work to do; and that the supervisor had bullied him in relation to the assignment of work.[21] And, as noted above, the applicant says that he worked on a particular project with minimal mentoring or support.[22] In addition, the applicant says that he was excluded from team meetings; that he was prevented from going to a particular training session; and that he was deprived of information about, and not permitted to work on, systems for which he had previously been responsible.
[21] See [44] above.
[22] See [50] above.
Most of these claims are supported only by the applicant’s evidence, and some of the evidence contradicts his claims.[23] However, it appears that the supervisor did shout at the applicant (and that the applicant shouted at the supervisor) during the mediation. This behaviour by the supervisor was probably unwise and unprofessional, but there is not sufficient evidence for us to find that it was bullying.
[23] For example, the supervisor and the project manager both deny that the applicant was excluded from team meetings.
And we think that the applicant was, as he claims, deprived of meaningful work, at least to some degree. We also think that the applicant was, as he claims, deprived of information about, and not permitted to work on, systems for which he had previously been responsible. At the hearing, the supervisor conceded that he had sent the applicant to various training courses, and told him to research some areas. He said that this was because the applicant did not have the necessary level of expertise to perform some of the tasks that the section had to perform. And, as noted above, the applicant was moved to another project after the mediation.[24]
[24] See [50] above.
There is also much evidence about how the applicant’s behaviour in the workplace was causing concern for his colleagues. And we think it likely that the main reason that the applicant was (as he puts it) “deprived of meaningful work” was that he was becoming increasingly difficult to work with. We note that it is not relevant to this review whether the agency’s decisions were reasonable.[25]
[25] Comcare does not argue that the exclusion from the definition of “injury” in s 5A (about reasonable administrative action) applies in this review.
At the hearing, the applicant conceded that some of the fault for the various workplace incidents was his. He says—and we can accept—that he had limited insight into his own behaviour at the time. Although it is not strictly relevant to the issues in this review,[26] we do not agree with the applicant that the agency should have taken action earlier, or taken different action when his behaviour at work became increasingly abnormal. As psychiatrist L said at the hearing, the early warning signs of the applicant’s psychotic illness (which include sleep disturbance, self-neglect, and distinct persecutory ideation) would not necessarily have been apparent to the applicant’s work colleagues, who were not working in the mental health field.[27] And the agency—including the supervisor and the HR area—would appear to have responded appropriately to concerns about the applicant’s mental state, by encouraging him to seek medical assistance and facilitating his reduction in working hours. We think it is likely that the agency’s decision to reduce the applicant’s workload—even to the extent that that involved assigning him little meaningful work—was a well-intentioned response to his behaviour at work.
[26] Liability under the SRC Act does not require negligence on the part of the employer. The SRC Act implements a no-fault scheme—with the possible exception of the exclusion in s 5A (see note 25 above).
[27] This was supported by psychiatrist I’s evidence at the hearing. He said that, in the lead up to a relapse, the applicant would probably tend to control the impulses that would otherwise be observable.
Notwithstanding that we think that the applicant was not bullied and harassed at work, we accept that he perceived that he was being bullied and harassed. He was clearly stressed by the incidents he reported in his December 2012 complaint. At various other times, he reported being stressed by his workplace: for example, to psychologist B in July 2013,[28] and to GP A in July and August 2013.[29]
[28] See [29] above.
[29] See [28] above.
In summary, we find, on the balance of probabilities, that the applicant was not subject to bullying and harassment in the workplace. He perceived the agency’s actions as bullying and harassment. His perception was not reasonable. But, as discussed below,[30] it does not matter whether the applicant’s perception of the agency’s actions was reasonable or unreasonable. The question is whether his employment by the agency contributed, to a significant degree, to the fourth episode.
Was the aggravation of the applicant’s ailment contributed to, to a significant degree, by his employment by the agency?
[30] See [92] below.
Under s 14 of the SRC Act, Comcare is liable to pay compensation in respect of an injury suffered by an employee if the injury results in death, incapacity for work, or impairment. Section 5A provides that an injury means, amongst other things, “a disease suffered by an employee”. Section 5B provides:
5B Definition of disease
(1)In this Act:
disease means:
(a) an ailment suffered by an employee; or
(b) an aggravation of such an ailment;
that was contributed to, to a significant degree, by the employee’s employment by the Commonwealth or a licensee.
(2)In determining whether an ailment or aggravation was contributed to, to a significant degree, by an employee’s employment by the Commonwealth or a licensee, the following matters may be taken into account:
(a) the duration of the employment;
(b) the nature of, and particular tasks involved in, the employment;
(c) any predisposition of the employee to the ailment or aggravation;
(d) any activities of the employee not related to the employment;
(e) any other matters affecting the employee’s health.
This subsection does not limit the matters that may be taken into account.
(3)In this Act:
significant degree means a degree that is substantially more than material.
Section 4(1) of the SRC Act provides that “ailment means any physical or mental ailment, disorder, defect or morbid condition (whether of sudden onset or gradual development)”; and that “aggravation includes acceleration or recurrence”.
In this review, Comcare is liable to pay the applicant compensation if the fourth episode was a “disease” for the purposes of the SRC Act. We have already found that the applicant’s fourth episode was a relapse of his chronic paranoid schizophrenia: an aggravation (a recurrence) of an ailment. It follows that the fourth episode is a disease if it was contributed to, to a significant degree, by the applicant’s employment.
The applicant points to a number of incidents that occurred during his employment with the agency, and says that those incidents contributed to the fourth episode. Comcare says that the first signs of the relapse that became the fourth episode emerged as early as December 2012, which predated most or all of the work events that could be said to have contributed to the fourth episode. The applicant denies this, and says that he did not become unwell until May 2013.
On 14 December 2013, GP B reported that he had first seen the applicant on 29 August 2013, and that the applicant “initially was not forthcoming with his symptoms except to say that [there was] a lot of conflict at the workplace and at home with his dad and his partner” (that is, his step-mother). GP B said that the date of the applicant’s impairment “with regards to his current relapse” (that is, the fourth episode) “could be any time after August 2012 when, as per [psychiatrist I]’s report, it is believed that he ceased his medications”.[31] GP B also reported that the applicant disputed this, telling him that “he started feeling unwell from May 2013” and that “his work performance had been good till May 2013”.
[31] See [31] above.
We have already found that the applicant exhibited several symptoms of relapse in the period between December 2012 and May 2013.[32] It is clear that the applicant’s work performance had shown signs of deterioration long before May. We find, on the balance of probabilities, that the first signs of the relapse that became the fourth episode emerged as early as December 2012. In making this finding, we note that the applicant ceased regular depot injections on 26 July 2012.
[32] See [71] above, under “the fourth episode”.
Comcare says that the applicant was experiencing a range of stressors in his home life before the fourth episode. The applicant says that there was no stressor in his home life that could have triggered the fourth episode, and that he had no problems at home until after he was unwell. He is generally supported in this by the evidence of his father and step-mother. We have already found that the applicant reported home stressors (to his work colleagues and his doctors) on several occasions between 29 March and the fourth episode on 18 September 2013. We find, on the balance of probabilities, that home stressors contributed to the applicant’s fourth episode. However, for reasons discussed below,[33] we do not need to make a finding about the extent to which those home stressors contributed.
[33] See [99] below.
Some of the workplace incidents that the applicant identifies actually occurred: for example, he was deprived of meaningful work, and deprived of information about, and not permitted to work on, systems for which he had previously been responsible.[34] And we think it likely that he was given minimal mentoring or support when working on a particular project from January to May 2013.[35] But the evidence before us does not disclose bullying and harassing behaviour on the part of the agency against the applicant. As psychiatrist I said at the hearing, a person without an illness like the applicant’s would be unlikely to be affected by the work stressors he described. Nonetheless, we find, on the balance of probabilities, that the applicant perceived the agency’s behaviour as bullying and harassment. We note that that finding is consistent with the paranoid aspect of his illness and the progression of his relapse in the time leading up to the fourth episode.
[34] See [80] above.
[35] See [50] above.
It is not necessary that the applicant’s perceptions of workplace incidents be objectively reasonable for his employment to have contributed, to a significant degree, to the fourth episode. As the Federal Court explained in Wiegand v Comcare Australia:
In my opinion it was open on the evidence for the tribunal to hold that one or more of the incidents or states of affairs about which Mr Wiegand raised complaint in the course of his evidence contributed in a material degree to an aggravation of the depressive disorder suffered by Mr Wiegand. For that to be the case there is no requirement at law that the interpretation placed on the incident or state of affairs by the employee, or the employee’s perception of it, is one which passes some qualitative test based on an objective measure of reasonableness. If the incident or state of affairs actually occurred, and created a perception in the mind of the employee (whether reasonable or unreasonable in the thinking of others) and the perception contributed in a material degree to an aggravation of the employee’s ailment, the requirements of the definition of disease are fulfilled.[36]
The claimed ailment in Wiegand was a depressive disorder, not schizophrenia, but the principle applies to this review. However, the definition of “disease” in the SRC Act has been changed since Wiegand: the contribution to the ailment or aggravation must now be “substantially more than material”.[37]
[36] (2002) 72 ALD 795 at 797 [31] per von Doussa J.
[37] Section 5B was inserted into the SRC Act on 13 April 2007 by the Safety, Rehabilitation and Compensation and Other Legislation Amendment Act 2007. Before that, the definition of “disease” (in s 4(1)) was restricted to “an ailment or an aggravation that was contributed to in a material degree by the employee’s employment”: see (2002) 72 ALD 795 at 795 [23] per von Doussa J. Nonetheless, the Court’s comments are applicable to this review.
The workplace incidents occurred. Those incidents created a perception in the mind of the applicant that he was being bullied and harassed at work. That perception was not reasonable. But the question remains: did the applicant’s perception contribute to a significant degree—to a degree that is substantially more than material—to the fourth episode?
At the hearing, Comcare conceded that a person’s perceptions could conceivably amount to a contribution that is substantially more than material. But Comcare says that that is not what happened in this case. It says that the main contributing reason for the fourth episode—the aggravation of the applicant’s mental health ailment—was his failure to take his medication. Other factors were not substantial. In fact, Comcare says, the adverse views that the applicant formed about his work, and the stress he experienced, were a result of his failure to take his medication.
We agree. We do not think that there is a sufficient connection between the applicant’s perception of workplace bullying and the aggravation of his ailment. Psychiatrist M reported on 20 December 2014 that, as the applicant was not taking medication, his “mental health would have deteriorated throughout 2013 as a natural progression of his pre-existing paranoid schizophrenia irrespective of his employment”.[38] The fourth episode happened on 18 September 2013; its first signs emerged as early as December 2012. On the basis of all of the evidence before us, we find, on the balance of probabilities, that the main cause of the fourth episode (the only cause that contributed to a degree that was substantially more than material) was that the applicant had not had a depot injection since 26 July 2012—that he was not taking any anti-psychotic medication.
[38] And, by implication, irrespective of any stressor, including expressed emotion within the family. We discuss this question at [98] below.
In making that finding, we have taken into account the fact that the applicant had a predisposition to a relapse of his chronic paranoid schizophrenia (the fourth episode) given the first, second and third episodes: see s 5B(2)(c) of the SRC Act.[39] We have also taken into account the applicant’s continuing failure to acknowledge that he suffers from chronic paranoid schizophrenia, and his history of avoiding treatment: see s 5B(2)(e).
[39] Section 5B is quoted at [85] above.
We have also taken into account the evidence that workplace stressors could have contributed to the fourth episode to only a limited extent, if any. At the hearing, the applicant asked psychiatrist M whether a workplace stressor could have triggered a relapse in his condition. Psychiatrist M answered that the accumulated observations of psychiatry do not show that the kinds of stressors that appear in normal life or in the workplace can aggravate such a condition, but they do show that stressors (expressed emotion) within the family can.[40] In support of his view, psychiatrist M referred to academic studies which show that no stressor, except for expressed emotion within the family, can have a statistically significant effect upon the probability of psychotic relapse in a population. Of course, that does not mean that a workplace stressor could never contribute to a psychotic relapse in a given individual. Psychiatrists I and L each said that workplace stressors could have contributed in some way to the applicant’s fourth episode.[41] But each said that any such contribution would have been less than the contribution of the applicant having stopped taking medication. As psychiatrist I explained, his medication would have protected him: stressors could affect him only when he was not on his medication.
[40] See [62]–[63] above.
[41] See [70] (psychiatrist I) and [68] above (psychiatrist L).
The applicant points to the fact that he did not experience a relapse during several lengthy periods when he was not taking medication. But the evidence before us strongly suggests that the applicant not being on his medication is a necessary, and maybe sufficient, condition for relapse. Each of the four episodes was preceded by:
·a period (of at least two months) during which the applicant was not on anti-psychotic medication; and
·one or more stressful events.
The applicant agrees that his failure to take medication was a factor in the fourth episode. But he says that it was not the only significant factor. On the evidence before us, we cannot be sure which stressful event triggered the applicant’s fourth episode. (If, as psychiatrist M says, relapses can occur for unknown reasons and may have nothing to do with observable stress,[42] then it is possible that none of the stressful events that happened before the fourth episode triggered it.) But the fourth episode would almost certainly not have occurred if the applicant had been on anti-psychotic medication in the weeks and months before.
[42] See [63] above.

The applicant’s perception of workplace bullying and harassment did not contribute to a significant degree to the fourth episode. The only factor that contributed, to a significant degree—to a degree that was substantially more than material—was the applicant not being on medication. It does not matter to what extent the home stressors contributed to the fourth episode. The fourth episode was not contributed to, to a significant degree, by the applicant’s employment.
Conclusion
The applicant’s ailment is chronic paranoid schizophrenia. The fourth episode was an aggravation of his ailment: a relapse of his chronic paranoid schizophrenia. The aggravation was not contributed to, to a significant degree, by his employment. The aggravation is not a disease for the purposes of s 5B of the SRC Act and, therefore, not an injury for the purposes of s 14. Comcare is not liable to pay the applicant compensation in respect of the aggravation of his ailment.
The publication of these reasons
At the hearing, the applicant said that, in 2012 and 2013, he believed that he did not suffer from a mental illness and did not need medication. He says that he now understands that he does, and that he came to that realisation in the course of going through the material prepared and collated for this review. Nonetheless, it is likely that the decision in this review, and these reasons for decision, will cause the applicant stress. We think it appropriate to order that these reasons for decision be made available to the applicant through his treating psychiatrist or treating psychologist, or another similarly qualified person. The publication of these reasons will be delayed until that has happened.

I certify that the preceding 101 (one hundred and one) paragraphs are a true copy of the reasons for the decision herein of Senior Member Popple and Member Hughson
...................[sgd].....................................................
Associate
Dated 16 November 2016

Dates of hearing 12–14, 16 and 19 September 2016

Applicant In person

Counsel for the Respondent Mr Charles Clark

Solicitors for the Respondent Sparke Helmore Lawyers

[2016] AATA 913

16 November 2016

Key Legal Topics

Areas of Law

Employment Law

Administrative Law

Legal Concepts

Causation

Statutory Construction

Appeal

Remedies

Expert Evidence

Procedural Fairness

Division	GENERAL DIVISION
File number	2014/4163
LTLL
APPLICANT
And	Comcare
RESPONDENT

Tribunal	Dr James Popple, Senior Member Dr Bernard Hughson, Member
Date	16 November 2016
Place	Canberra

Dates of hearing	12–14, 16 and 19 September 2016
Applicant	In person
Counsel for the Respondent	Mr Charles Clark
Solicitors for the Respondent	Sparke Helmore Lawyers